| Continuous blood purification(CBP)refers to all the continuous removal of solute,the function of the organs play a variety of blood purification technology.which is another important means of respiratory support,nutritional support,has been widely used in critically ill patients,such as acute kidney injury,severe metabolic disorders,refractory fluid overload and some drug poisoning patients.CBP treatment in the control of capacity balance,removal of solute,to maintain acid and alkali,electrolytes and other internal stability of the advantages lies in its continuity,and to ensure the continuity of treatment is the key to the blood circulation circuit and filter anticoagulation.Piping and filter need to re-replace after the coagulation,so that the termination of treatment,fail to achieve the purpose of continuous treatment,resulting in patients with unplanned under the machine,resulting in patients with blood loss,reduce CBP treatment effect,increase nursing burden.Anticoagulation is the key to the continuity of cardiopulmonary bypass,the traditional citrate anticoagulation method due to the replacement of the replacement bag and the machine midway self-test caused by anticoagulation stop,and the effect of the filter clearance,so that the extracorporeal circulation is still occurred,we proposed in the original amount of citrate on the basis of anticoagulant,by changing the infusion of citric acid,to reduce the occurrence of extracorporeal circulation of coagulation,the study consists of two parts:Study 1: Effects of Different Infusion Methods of Citric Acid on Cardiopulmonary bypass coagulation in Daytime CRRTOBJECTIVE To observe the anticoagulation effect of different citric acid infusion in Daytime CRRT,and to find a safer and effective method for citric acid infusion.METHODS A total of 62 patients were treated with extented daily dialysis from October 2016 to June 2017 in the Department of Hematology,Institute of Nephrology,Nanjing General Hospital.Treatment time of 8 hours,October 2016 to December 2016,the use of a program for infusion: the traditional citrate infusion method,the citrate all added to the replacement solution.A total of 14 patients,20 cases of treatment;2017 January to 2017 in April using the two infusion: the modified citrate infusion method,citric acid part of the replacement fluid,part of the arterial That is pumped before the filter pump.A total of 18 patients were enrolled in 22 patients.From April 2017 to June 2017,the infusion was performed using regimen: an improved citrate infusion method,and citric acid was added to the replacement fluid,That is,the pump before the filter continued to pump,part of the continuous pot in the pot.A total of 15 patients were treated with 20 cases of treatment.The anticoagulant effect and complications of cardiopulmonary bypass were observed and compared.RESULTS Compared with protocol 2,the two groups of patients’ cardiopulmonary bypass use time,filter service life and ionized calcium value were all lower than that of protocol one.The difference was statistically significant(P<0.05);The occurrence of coagulation and metabolic complications in the pots: There was no statistical difference in hypocalcemia and metabolic acidosis(P>0.05).2.Compared with protocol 3,the three groups of patients’ cardiopulmonary bypass use time,filter service life,and jugular hemostasis protocol were lower than protocol 1,and the difference was statistically significant(P<0.05);The occurrence of complications;the difference was not statistically significant(P>0.05).3.Compared with Option 3 and Option 3,there was no significant difference in the use time of cardiopulmonary bypass,the service life of the filter,the coagulation of veins in the jug,and the metabolic complications in the two groups(P>0.05).CONCLUSION The in vitro anticoagulant effect of regimen 2 and protocol 3 in CRRT at 8 hours during the day is higher than that of protocol 1,and the coagulation of the three veins in protocol 3 is lower than that in protocol 2.Study 2: Effects of Different Infusion Methods of Citric Acid on Coagulation in Patients with Continuous Blood PurificationOBJECTIVE To observe the anticoagulation effect of different citric acid infusion in continuous blood purification,and to find a safer and effective method for citric acid infusion.METHODS A total of 17 patients were treated with CRRT from hematology in the Department of Hematology in Nanjing General Hospital from April 2017 to September 2017.The treatment time was 96 hours.Between April 2017 and July 2017,the infusion was carried out in the following manner: the modified citrate infusion method,part of the citric acid was added to the replacement fluid,and the part was continuously pumped before the pump end of the pump.A total of 8 patients were followed up for 17 patients.From August 2017 to September 2017,the infusion was performed using regimen: an improved citrate infusion method,and citric acid was added to the replacement fluid,That is,the pump before the filter continued to pump,part of the continuous pot in the pot.A total of 9 patients were treated with 18 cases of treatment.The anticoagulant effect and complication of cardiopulmonary bypass were observed and compared.RESULTS The protocol 2 of patients’ cardiopulmonary bypass use time and filter service life plan were both lower than that of protocol 1(P<0.05).The ionized calcium value of the protocol 2 was higher than that of protocol 1 when the bags were replaced(P<0.05).There was no statistical difference in the occurrence of venous coagulation and metabolic complications between the two groups of patients: hypocalcemia and metabolic acidosis(P>0.05).CONCLUSION The anticoagulant effect of protocol 1 is better than that of protocol 2.Comprehensive study one and study two,protocol 1 partial citrate infusion method can reduce the incidence of extracorporeal circulation coagulation,safe and effective. |
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